Dysfunction of upper gastrointestinal tract in critically ill patients: current view and prospects

Česká verzia

Authors: K. Balihar; J. Koželuhová; L. Fremundová; M. Matějovič
Authors place of work: I. interní klinika, Oddělení gastroenterologie a hepatologie a Jednotka intenzivní péče, LF UK a FN Plzeň
Published in the journal: Gastroent Hepatol 2013; 67(1): 39-44
Category: Clinical and Experimental Gastroenterology: Review Article

Summary

Acute gastrointestinal dysfunction being one of the aspects of multi-organ dysfunction syndrome in critically ill patients is a frequent problem in intensive care and is associated with high morbidity and mortality. In the upper gastrointestinal tract, the dysfunction is manifested as a stress-induced ulcer syndrome and a complex motility disorder leading to intolerance of gastric enteral nutrition and reflux esophagitis in duodenogastroesophageal reflux, with a high risk of aspiration and nosocomial pneumonia. The key pathogenetic mechanisms are (i) splanchnic hypoperfusion leading to breakdown of the barrier function of stomach mucosa that results in mucosal erosions and ulcers, (ii) weakening or loss of lower oesophageal sphincter tonus, and (iii) reduction and loss of effectiveness of prograde gastric evacuation. Complications of this gastrointestinal dysfunction can be reduced by routine support care for critically ill patients, such as basic hemodynamic stabilization, adequate tissue oxygenation, and, if possible, influencing the causal problem. In indicated cases of this dysfunction, prophylaxis of the stress-induced ulcers, prokinetics administration, and potential insertion of a double-luminal probe suitable for both derivation and nutrition, to bypass the motility disorder of the upper gastrointestinal tract in the case of intolerance of gastric enteral nutrition, may be used in treatment.

Key words:
critical illnes – gastroesophageal reflux – esophageal motility disorders – mechanical ventilation – multiple organ dysfunction syndrome

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
14. 1. 2013

Accepted:
31. 1. 2013

Zdroje

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